- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $707.95 / $6,918.31
| Facility | | $23.99 | $707.95 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $107.15
| Professional | | $26.92 | $47.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $30.20 / $70.79 / $165.96
| Professional | 50 | $30.20 | $70.79 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $36.31
| Professional | | $25.70 | $34.67 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $4,265.80 / $12,302.69
| Facility | | $29.51 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $48.98
| Professional | | $22.39 | $28.18 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $45.71 / $107.15
| Professional | | $23.44 | $45.71 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,041.74 / $3,388.44
| Facility | | $1,412.54 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $24.55 / $54.95
| Professional | | $19.50 | $24.55 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $33.11
| Professional | | $21.88 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,412.54 / $3,630.78
| Facility | | $162.18 | $1,412.54 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $72.44
| Professional | | $26.30 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $28.84
| Professional | | $21.88 | $21.88 | $28.84 |